Chronic bronchitis natural history, complications and prognosis
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Several determining factors have been known to influence the course of chronic bronchitis including: cigarette smoking, level of airflow obstruction, and recurrent infection. It may be complicated by pneumonia, cor-pulmonale or anemia. Also, because of chronic nature of this disease, depression and increased risk of lung cancer are expected to seen in the disease course. Prognosis depends on early diagnosis and adequate treatment. However, FEV1 level is the most important prognostic factor.
Prognosis may vary depending on the time of diagnosis and severity of airflow obstruction, which may be measured by FEV1, FVC and FEV1/FVC. Chronic Bronchitis has a wide range of severity from well controlled chronic bronchitis to severe obstructed airways with multiple exacerbations that require hospitalization and even may develop into lung cancer. COPD gradually deteriorates over time and can lead to death if left untreated.
Common complications of chronic bronchitis include:
- Recurrent pneumonia: chronic inflammation and airways damage predispose chronic bronchitis patients to recurrent pneumonia either viral or bacterial infections. Additionally, chronic use of inhaled corticosteroids may cause recurrent infections
- Depression: may require psychiatry consultation
- Cor pulmonale: chronic hypoxia and subsequent vasoconstriction in pulmonary vasculature results in pulmonary hypertension and right sided heart failure, termed cor pulmonale
- Anemia: anemia of chronic disease may develop in this patients and indicates a poor prognosis.
- Polycythemia: secondary to chronic hypoxemia, Hematocrit level may rise up to 60 (normal range: adult men: 46±4, adult women:40±4).
A good prognosis of COPD relies on an early diagnosis and prompt treatment. Majority of patients will have improvement in lung function once treatment is started. The most important prognostic factor is the FEV1 level. Other determining factors include:
- Cigarette smoking
- BMI ≤ 21
- Decreased exercise capacity
- Increased C-reactive protein level
- Co-morbid diseases
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